Reformulation without substitution as a strategy to reduce children's free sugar intake in Uruguay: A simulation...

Product reformulation is a promising strategy to address excessive free sugar consumption among children, yet mandatory programs remain rare across the globe. This study explores reformulation scenarios to reduce free sugar in processed foods without using nonsugar sweeteners in Uruguay, a high-income Latin American country.

A two-stage approach was applied: 1) development of reformulation policy scenarios, and 2) simulation of their potential impact on children's free sugar intake. First, analysis of 2 national dietary surveys (24-h recalls) identified key product categories contributing to free sugar intake among children aged 6-59 mo and 4-13 y. A market database of processed and ultra-processed foods was then used to examine sugar content distribution. Second, the impact of each scenario was modelled by simulating changes in product sugar content within these categories and applying them to intake data.

Two policy options, inspired by sodium reduction strategies, were tested: maximum sugar levels and percentage reductions. Simulations indicated that percentage reductions would require reformulation of a larger proportion of products, resulting in greater decreases in average sugar content and higher effectiveness. Only this scenario yielded a statistically significant reduction in modelled free sugar and energy intake among children aged 6-59 mo. For both age groups, reductions approached 10%.

Sugar reformulation can lead to meaningful public health gains in the Uruguayan context. However, post-reformulation sugar intake remained above recommendations, highlighting the need for complementary measures to further discourage excessive consumption.